Basic Information
| Provider Information | |||||||||
| NPI: | 1033856166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKESHORE ASSISTED LIVING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 638 SOUTHBEND AVE | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560012168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076258741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 8TH ST NW | ||||||||
| Address2: | |||||||||
| City: | WASECA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560931907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076258741 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2022 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| AuthorizedOfficialLastName: | REKANT | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF RCM | ||||||||
| AuthorizedOfficialTelephone: | 5072031031 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.